JACQUELINE WHITAKER
Mirra Healthcare
Homosassa,FL
18
years of professional experience
Detail-oriented Credentialing Specialist skilled in application verification and data access management. Expertise in ensuring compliance and accuracy through primary source verification and access-level tier management. Proven ability to navigate complex certification and credential requests while fostering strong professional relationships.
Work History
Billing/Credentialing Specialist
5 Months- Submit weekly therapy claims to Medicare, commercial, and secondary payers
- Followed up on unpaid/underpaid claims to resolve discrepancies and ensure timely reimbursement
- Review denials, identify root causes, and submit appeals
- Post payments and adjustments in Net Health accurately
- Maintain AR aging reports and meet productivity benchmarks
- Handle patient billing inquiries and collections (copays, coinsurance, deductibles)
- Identified trends affecting reimbursement and escalated issues. Credentialing & Enrollment
- Manage Medicare Part B enrollment and updates via PECOS
- Submit and track credentialing applications for all payers
- Maintain CAQH profiles and provider records
- Monitor credentialing expirations and renewals
- Communicate with payers regarding application status
- Ensure compliance with regulatory and audit requirements
PROVIDER CREDENTIALING COORDINATOR
1 Year 2 Months- Process initial credentialing and recredentialing applications across multiple specialties (e.g., primary care, specialists, behavioral health, allied health, facility-based)
- Conducted Primary Source Verification (PSV) tasks to maintain accuracy and integrity in credentialing processes.
- Performed verifications with AMA/AOA state medical boards to ensure licensing compliance for providers.
- Verified CAQH attestations to maintain compliance with credentialing standards.
- Confirmed state licensure and Medicare/Medicaid enrollments.
- Performed OIG and SAM exclusion checks to maintain compliance with regulatory standards.
- Utilized National Student Clearinghouse to confirm educational credentials of healthcare providers.
- Processed Freshworks ticket requests from providers to update demographic information in Credential Stream system, enhancing accuracy of provider directory and supporting compliance in provider operations.
PATIENT CARE COORDINATOR
2 Years 8 Months- Verified insurance, obtained referrals, prior authorizations, and continuation of authorizations through insurance websites and Availity to facilitate timely patient care.
- Processed patient payments and finalized plans of care to support patient financial responsibility and care continuity.
- Entered patient, insurance, and provider information into Epic and maintained accurate records.
- Ordered supplies, answered phones, and scheduled patient evaluations and follow-up appointments to maintain efficient patient flow and enhance care coordination.
CENTER DIRECTOR
2 Years 10 Months- Managed business operations, achieving revenue and profitability targets while leading the assigned center.
- Drove center traffic, increased sales, and enhanced brand awareness in local market.
- Coached clients through weight loss journeys, conducting daily outbound care and sales calls to improve client retention rates.
- Drove center traffic and increased sales while enhancing brand awareness in local market.
- Ordered supplies, stocked inventory, and performed weekly inventory checks to maintain optimal stock levels.
RECORDS COORDINATOR
6 Months- Managed electronic and paper records for care center, providing organized and accessible documentation for staff and patients to support efficient operations.
- Facilitated timely uploads of documents into EMR, improving data accessibility for clinical staff and enhancing patient care.
- Organized and scanned into the system four months of backlogged medical records, bringing all files to be current within a month.
- Prepared admission packets, processed orders and 485s, scheduled patients, and obtained authorization to streamline patient intake and ensure timely care.
- Prepared admission packets, processed orders and 485s, scheduled patients, and obtained authorization.
- Executed administrative tasks including receiving faxes, answering multi-line phones, performing data entry, ordering supplies, and managing billing processes.
PROVIDER CREDENTIALING/DATA ANALYST
9 Years 11 Months- Entered and maintained contract data and provider fee schedules for in-network and out-of-network providers, ensuring accuracy for physicians, ancillary groups, and hospitals.
- Coordinated with health plan credentialing and provider relations representatives on credentialing, re-credentialing, and demographic updates to expedite processing.
- Resolved issues raised by providers and internal/external customers through detailed research and analysis.
- Devised protocol to sort and filter information for loading hundreds of providers and payments into system. Ensuring compliance with production and quality standards.
- Compiled spreadsheet of providers with billing address, TIN, NPI, and specialty/department, enhancing selection of accurate provider records for claim payments and reducing instances of duplicate and non-par loads.
- Achieved company quality and production standards consistently throughout tenure.
- Supported multiple platforms to enhance project flexibility and efficiency.
Education
PARALEGAL STUDIES
GED
Skills
Insurance verification
Medical records
Data evaluation
Scheduling
Records administration
Data entry accuracy
Credentialing management
Excel proficiency
Provider scheduling
Compliance documentation
Timeline
Billing/Credentialing Specialist
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PROVIDER CREDENTIALING COORDINATOR
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PATIENT CARE COORDINATOR
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CENTER DIRECTOR
Jenny Craig
10.2019 - 08.2022Read More
RECORDS COORDINATOR
Amedisys Home Health
01.2019 - 07.2019Read More
PROVIDER CREDENTIALING/DATA ANALYST
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12.2008 - 11.2018Read More
Amelia County High School
GED
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Bryant & Stratton
PARALEGAL STUDIES
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